Healthcare Provider Details

I. General information

NPI: 1710561170
Provider Name (Legal Business Name): KYLE HUFF CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MIDDLETOWN AVE
NORTH HAVEN CT
06473-3927
US

IV. Provider business mailing address

15 CURTISS AVE
WEST HAVEN CT
06516-5411
US

V. Phone/Fax

Practice location:
  • Phone: 203-865-3179
  • Fax: 203-752-1164
Mailing address:
  • Phone: 203-710-9048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0012348
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: